How useful is a physical exam in diagnosing testicular torsion?

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Abstract

Physical exam is useful, but imperfect, in ruling out testicular torsion (strength of
recommendation [SOR]: C, expert opinion).
The cremasteric reflex or a nontender
testicle usually excludes testicular torsion,
but case reports have noted the opposite to
be true (SOR: C, case series). An abnormal
testicular lie can help establish the
diagnosis, but occurs in fewer than 50% of
cases (SOR: C, case series). Other findings
are less reliable (SOR: C, case series). The standard of care for diagnosing testicular torsion relies on studies beyond the physical examination (SOR: C, expert
opinion).